All applications are subject to review and approval by the Physician Assistant Committee and the Medical Licensing Board of Indiana.

Limit of Physician AssistantIn accordance with IC 25-27.5-6-2, a physician may have supervisory agreements with more than two (2) physician assistants, however may not supervise more than two (2) physician assistants at any given time.

Documents Required for Licensure

Completed Application - You and yo

ur Supervising Physician must complete, date and sign the Application for prescriptive authority. All information must be completed on the application or have N/A for not applicable. Please be sure to include an email address, as status updates will be sent via email.

Application Fee - At this time a fee is not required for prescriptive authority applications; however, there is a fee attached to the Controlled Substance Registration application of $60.00.

Positive Responses - If you have answered any of the questions on the application “yes” you must submit a notarized affidavit detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment include the amount paid on your behalf. If applicable, please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement, however they may be included with your statement.

Supervisory Agreement - The agreement must meet the requirements stated in IC 25-27.5-5-2. The Supervising Physician shall submit a description of the exact privileges and tasks the physician assistant shall be performing under the physician’s supervision. The supervisory agreement shall be specific to the physician assistant being hired “i.e. John Brown, PA will be responsible for…” In addition give a detailed description of the process maintained for evaluation of the physician assistant’s performance. Also include a description of procedures for dealing with emergencies. The supervisory agreement must be on letterhead and signed by both the physician and physician assistant. The supervisory agreement must also include a list of classifications of medications the physician assistant is delegated to prescribe and a description of protocols used in the practice. Protocols to be used for physician assistant prescribing may include clinical practice guidelines, reference texts, or other sources. You are also required to specifically list all locations that the supervising physician and physician assistant will practice.

If you are seeking to prescribe scheduled drugs, you must specifically state in the agreement that you may prescribe those "in an aggregate amount, that does not exceed a thirty (30) day supply. Any refills or subsequent prescriptions beyond the thirty (30) day supply must be authorized by the supervising physician and recorded in the patient's medical records."

If you are seeking to prescribe non-controlled substances, you must specifically state this in your agreement. Example: "The physician assistant will only be prescribing non-controlled substances."

Continuous Employment - Only PAs that have practiced as a physician assistant for at least one (1) year and have worked at least 1,800 hours after graduating from an approved physician assistant program, are eligible to prescribe controlled substances. If you are seeking to prescribe controlled substances, you must provide proof of those practice hours by submitting a letter from your employer/supervisor. This letter must be on letterhead paper or have the name, address, phone number of the supervising physician/practice location at the top of the letter.

Proof of Pharmacology - You must submit proof of thirty (30) hours in pharmacology. A contact hour is 50-60 minutes of instruction in the area of pharmacology. Credit hours from a physician assistant program approved by the committee are acceptable. One credit hour is equal to 10 contact hours. Category 1 Continuing Medical Education is also acceptable. Certificates must be submitted for proof of CME’s.

Chart ReviewA supervising physician or physician designee shall review all patient encounters not later than 72 hours after the PA has seen the patient.

For the first year of employment of the PA 100%

For the second year of employment of the PA 50%

For the third year of employment and thereafter 25%

If a physician assistant changes supervising physicians but remains in the same practice specialty, the schedule of chart review above does not start over. However, if the physician assistant is employed in a different practice specialty, the full scheduled of chart review above must be followed.

Controlled Substance Registration - If you are going to prescribe, dispense or administer controlled substances you must also apply for a Controlled Substance Registration. Please review the Controlled Substance Registration instructions. If you already have authority to prescribe legend drugs, you will need to submit an updated practice agreement indicating your authority prescribe controlled substances with the CSR.